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37.87.703    MENTAL HEALTH CENTER SERVICES FOR YOUTH WITH SERIOUS EMOTIONAL DISTURBANCE (SED), COVERED SERVICES

(1) Mental health center services for youth with serious emotional disturbance include:

(a) Community-based psychiatric rehabilitation and support (CBPRS) services:

(i) are provided on a face-to-face basis primarily with a youth, and may also include consultation on a face-to-face basis with family members, teachers, employers, or other key individuals in the youth's life when such contacts are clearly necessary to meet rehabilitation goals established in the youth's individual treatment plan;

(ii) may only be provided when the youth is receiving other mental health services;

(iii) require prior authorization by the department or its designee when provided for a youth in the PRTF waiver during day treatment program hours;

(iv) do not require prior authorization when provided on the same day as CSCT, Day Tx, or partial hospital services, if CBPRS is provided before or after program hours. This includes both individual and group CBPRS. Documentation of CBPRS must include time in and time out to show that CBPRS was not provided during program hours;

(v) are not allowed when the service to be provided is:

(A) during day treatment program hours unless the youth is in the PRTF waiver and CBPRS services are prior-authorized;

(B) during CSCT or partial hospital program hours;

(C) provided by a licensed mental health professional;

(D) for the purpose of habilitation, academic instruction, recreation, vocational, or pre-vocational training;

(E) in a therapeutic group home, hospital, psychiatric residential treatment facility, or other residential facilities;

(F) case planning activities such as attending meetings, completing paperwork, and other documentation requirements or travel time; and

(G) solely for the purpose of safety.

(vi) may not exceed the following limits for group:

(A) up to a maximum of two hours per day;

(B) up to a maximum of eight youth per group; and

(C) up to a staff ratio of four youth to one staff.

(b) Comprehensive school and community treatment in accordance with ARM 37.86.2224.

(c) Youth day treatment services as defined in ARM 37.87.702.

(d) In-training mental health professional services as defined in ARM 37.87.702. Services are subject to the same requirements that apply to licensed mental health professionals.

(e) Outpatient therapy services provided according to an individualized treatment plans and includes:

(i) psychotherapy services provided in accordance with the current edition of the American Medical Association's Current Procedural Terminology, Professional Edition, and codes approved by the department. The department adopts and incorporates by reference this manual;

(ii) family therapy, provided with or without the youth present, directed at the eligible youth's mental health needs and their impact on the family dynamics; and

(iii) individual and family therapy are targeted at reducing or eliminating symptoms or behaviors related to a youth's mental health diagnosis as specified in the treatment plan.

(f) Targeted case management services as defined in ARM 37.87.802.

(g) Mental health professional services, which include the professional component of physician or psychiatrist services covered in ARM 37.86.101, 37.86.104, and 37.86.105:

(i) Mental health professional services are subject to the following limitations:

(A) To the extent otherwise permitted by applicable Medicaid rules, such mental health professional services may be billed by the mental health center either as mental health center services or by the mental health professional under the applicable Medicaid category of service, but may not be billed as both mental health center services and mental health professional services.

(B) Mental health professional services may be covered and reimbursed by Medicaid only if the mental health professional is enrolled as a provider and the services are provided according to the Medicaid rules and requirements applicable to the mental health professional's category of service.

History: 53-2-201, 53-6-101, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, MCA; NEW, 2009 MAR p. 272, Eff. 2/27/09; AMD, 2011 MAR p. 49, Eff. 1/15/11.

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